Background. The differentiation of duodenal perforation from duodenal hemat
oma is not always possible with computed tomography (CT). Our diagnostic gu
ideline has included duodenography to investigate CT findings of periduoden
al fluid or wall thickening. However, the utility of duodenography as a dia
gnostic study in blunt abdominal trauma is not defined. We evaluated duoden
ography as a diagnostic test in patients with suspected blunt duodenal inju
ries (BDIs).
Methods. During a 10-year period, 96 patients out of 25,608 trauma admissio
ns had CT findings of possible BDI and underwent duodenography. Demographic
and clinical data, diagnostic methods, and management were derived from pr
ospectively collected data. CT and duodenography studies were reviewed and
correlated with surgical findings and outcome. All CT scans were obtained w
ith intravenous contrast; oral contrast was used in 32 patients. Duodenogra
phy was analyzed using the 2 X 2 method and Bayes theorem.
Results: Indications for duodenography included periduodenal fluid without
extravasation (76%), abnormal duodenal wall thickening (16%), and retroperi
toneal extraluminal gas (5%). Eighty-six duodenography studies were reporte
d as normal, six were consistent with hematoma, one was indeterminate, and
only three revealed extravasation. Two of these three patients with duodena
l perforation had retroperitoneal extraluminal air. Only one patient underw
ent exploration on the basis of duodenography. No blunt duodenal perforatio
n was diagnosed by CT. Overall, duodenography had sensitivity of 54% and sp
ecificity of 98%. For BDIs requiring repair, duodenography sensitivity was
only 25%; the false-negative rate was also 25%. Retroperitoneal extralumina
l air was a useful sign of duodenal perforation, occurring in two of three
patients with BDI and only in one without BDI (p < 0.001).
Conclusion Duodenography has a low sensitivity in patients with suspected B
DI by CT findings and is of minimal utility in diagnostic evaluation. Retro
peritoneal extraluminal air seen on CT is an important sign of BDI requirin
g surgical repair.